Healthy Hearts in the West

Two Years in a Nutshell

Index

1) Opening Statement

2) Tackling Health Inequality through a Community Development Approach

3) Marmot in Action

4) Physical Activity

5) Healthy Eating and Heart Health

6) Fit Kids

7) The Springvale Pathway to a Whole Organisation Health and Wellbeing

Strategy

8) A Healthy School – Corpus Christi College

9) Healthy Hearts in the West Community Pharmacy

10) Delivering Cardiac Rehabilitation Phase 3 in a Community Setting

11) A Critical Reflection of the Healthy Hearts in the West Initiative

12) Ooops ~ what could be improved and gaps in the development and

delivery of Healthy Hearts in the West

13) Recognition and Legacy

14) Tool Kit

Report by Jane Turnbull Healthy Hearts in the West Evaluator/Researcher

supported by Rowan Davison and Joanne Wright

Healthy Hearts in the West (HHW) was conceived as a community based approach

to tackling the underlying risk factors for cardiovascular disease in West Belfast. The

proposal came from the Health Committee of the West Belfast Partnership but from

the outset engaged with a broad range of partners both statutory and community.

From the outset evaluation was built into the Healthy Hearts Initiative and many

lessons have been learnt along our two year journey. HHW involved a fair amount of

experimentation and some aspects of the programme worked better than others but

added valuable learning for both HHW and future initiatives.

HHW has made an impact in communities’ schools and workplaces, involving over

10,000 people. We have tried where possible to make this work sustainable for

example; the Fit Kids programme with Belfast City Council, the work with Springvale

Training and Cardiac Rehabilitation Phase 3 in the Maureen Sheehan Centre.

This booklet is a celebration of the efforts and achievements over the past two years

and a recognition of all those who made this possible. The booklet, along with the

Healthy Hearts Toolkit, which will be available together with a wealth of evaluation

material, will leave a strong and enduring legacy. Hopefully this will be taken on

board by mainstream services.

Rowan Davison

Healthy Hearts in the West Co-ordinator

Acknowledgement

The data and analysis that has informed this Booklet has been collected through a formative

evaluation process. This has been supported throughout the Initiative by:

Dr. Christine McMaster Public Health Agency

Professor Margaret Cupples Queen’s University Belfast

Julie Neil Public Health Agency

Diane McIntyre Public Health Agency

Anne Hillis Health and Social Care Board – Belfast Local Commissioning Group

Adele Graham Public Health Agency

The Healthy Hearts in the West Hub Coordinators – Janine Crawford and Marty McCartney

Tackling Health Inequality through a Community Development Approach

The Healthy Hearts in the West (HHW) Initiative sought to demonstrate that a collaborative, community assets approach can support the delivery of key health targets and priorities, as well as offering an innovative approach to addressing health inequality.

The development and delivery of the HHW Initiative was built on community development principles. There are five key values underpinning all community development practice:

• Equality and anti-discrimination

• Social justice

• Collective action

• Community empowerment

• Working and learning together

Tackling Health Inequality through a Community Development Approach

Equality and Anti-Discrimination The overall aim of HHW is to address heart health inequality. The Initiative challenges the status quo; and has supported the community to identify needs and ways in which to address risk factors to heart health.

Social Justice

HHW promotes human rights through raising awareness and understanding of the risk factors to heart health.

The Initiative has facilitated risk assessment making opportunities more accessible through the HHW Community Pharmacy Programmes and health checks at Healthy Heart events.

HHW challenges the underlying causes and effects of structural power and inequalities.

The Initiative takes into account cultural and community characteristics; and has made linkages between local and regional contexts, policy, infrastructure and wider health initiatives.

Collective Action

HHW builds on the community assets model. It recognises existing skills and assets within the community, seeking to promote existing heart health programmes and events to people in the community. The HHW team have supported local community groups to organise events, and has sought to build capacity in relation to heart health through a range of training programmes (most of which have been delivered by partner organisations including the British Heart Foundation and Belfast Health and Care Trust).

Community Empowerment

HHW encourages the wider community to work together. The HHW infrastructure (for example the cross-sectoral Steering Group and Operations Management Group) facilitates equality across the sectors enabling communities to define themselves, their priorities, and agendas for action. This in turn promotes participation in the decision making processes.

Throughout the Initiative the community has been consulted: for example during the initial Planning Days, the Baseline Surveys, and ongoing evaluation and review.

HWW has supported the delivery of heart health related training programmes, building community capacity.

Working and Learning Together

Throughout the HHW Initiative, emphasis has been placed on collaboration and partnership across the community, voluntary, statutory and private sectors. Working together has:

Increased understanding of how different organisations can support the work of others

Identified opportunities for collaborative working to help organisations meet their targets

Contributed to more effective and efficient use of (limited) resources. Ongoing research, analysis and formative evaluation has informed the development and review of the Initiative. Critical reflection has highlighted what worked well, good practice, where there have been gaps, and where improvements could be made. This has led to documenting lessons learnt which can be used to inform and develop future initiatives.

Community Development National Occupational Standards The HHW Initiative links directly to the majority of the 25 UK National Occupational Standards. The standards are categorised in seven ‘key areas’: 1. Understand and practise community development 2. Understand and engage with communities 3. Take a community development approach to group work and collective action. 4. Promote and support a community development approach to collaborative and cross

–sectoral working. 5. Support community learning from shared experiences. 6. Provide community development support to organisations 7. Manage and develop community development practice

It is useful to reflect on the 25 Community Development National Occupational Standards and consider the extent to which the HHW Initiative has met and delivered on the different Standards. Further Information:

Critical Reflections Document (March 2014)

http://www.fcdl.org.uk/

Marmot in Action

The Marmot Review (2010) highlighted the need for:

Coproduction and collaboration across all sectors - public, community, voluntary and private

Challenges to existing structures

Building mutual reliance and respect to address social determinants of health inequalities

Healthy Hearts in the West has promoted…

Multi-sectoral collaboration, in West Belfast

A community assets approach to better utilise existing resources addressing heart health inequality

Increased accessibility of services to promote heart health and support people with or at risk of heart disease

The model values and builds on: community capacity; local context, knowledge, culture, social and material assets; connections and linked initiatives. The development, delivery and evaluation of the HHW initiative are supported by a logic model and based on the National Institute for Clinical Excellence recommendations on Behaviour Change at Population, Community, and Individual levels

HHW: Fit Kids

The Fit Kids Survey (2012) of 1760 pupils 7-10 years old in 19 Primary Schools providing a snapshot of physical activity and diet. Highlights from this survey showed

25.5% engage in one hour of physical activity every day ~

42.4% only do physical activity three or less days a week

28% eat five portions of fruit & vegetables a day

Fit Kids Physical Activity and Nutrition Programme was developed in partnership between HHW, Belfast City Council, Belfast Health and Social Care Trust and Extended Schools. 1415 children from 17 schools have participated in the Programme. Follow-up Fit Kids survey (2013) show increased physical activity levels. Following negotiations, the Fit Kids Programme has been sustained in 2013-2014 through delivery by Belfast City Council Active Communities.

Corpus Christi College

Health Day for 40 staff which included: health checks, complementary therapies, nutrition Advice and physical activity taster sessions. Health check data showed:

12 staff were within BMI target weight, (i.e. over two thirds were outside the BMI target weight) 7 staff were obese with a BMI over 30.

6 staff were signposted to the HHW Vascular Risk Screening Programme.

7 staff were advised to make an appointment with their GP.

Evaluation on the day and three months later showed the impact of the Health Day:

95% of staff made more health lifestyle changes than they had anticipated

7 staff (who were signposted) made and attended a GP appointment

27 staff reported eating more healthily

22 staff take more exercise

22 staff drink more water

14 staff started walking regularly

Senior management of Corpus Christi College:

Linked the health day with the new College Fitness Suite for staff and local residents

Piloted Heart Health Programme for pupils in Year 8 and Year 9 (aged 11–13 years)

Are developing a whole College health approach

Critical Factors / Lessons

Partnership in action:

specific tasks agreed by partners

win:win for partners (meeting targets )

Clear communication is needed for effective ‘joined-up’ working

Committed health champions identified at community level

Value of follow-up evaluation

Links with existing infrastructure: support delivery and sustainability

Benefit of the collaborative strategic Steering Group and action-focused Operations Management Group

Allow for innovation and taking risks

Positive lifestyle changes through individual and group interventions

One of the core aims of the Healthy Hearts in the West Initiative was to raise awareness of the risk factors that contribute to cardiovascular heart disease, and to promote opportunities for people of all ages living in West Belfast to access programmes and activities that help combat risk factors. A lack of physical exercise is one of the risk factors to heart health.

Guidelines from the Chief Medical Officer state that children and young people should participate in at least one hour of physical exercise every day. Adults should aim to be active daily; over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least five days a week (www.gov.uk/government/publications/uk-physical-activity-guidelines).

Building on the community assets approach (in this instance programmes and activities already taking place in the community through Sports Clubs and community groups) and working in partnership with statutory and voluntary organisations, HHW promoted and supported physical activity programmes and events across West Belfast.

Physical Activity

Physical Activity with Children

Fit Kids Programme Physical Activity and Nutrition Programme delivered in Falls, Andersonstown and Whiterock Leisure Centres involving over 1400 Primary School Children from 17 Primary Schools

Multi-Sports Event at Sarsfields (March 2012), involving over 400 children; with coaches from Active Communities and the GAA

Junior Olympics at Casement Park (June 2012), linking in with a Health Information Day for parents

St. John the Baptist Primary School: 6 week coaching programme

12 weeks programme of cultural dance delivered in ten venues; which included Irish Dancing, Zumba, Hip Hop, and Indian Dance. The ten venues included nursery schools, primary schools, youth clubs and after schools groups.

Physical Activity with Young People

Springvale Employment and Learning Solutions: Fit 4 Work Programme delivered to 90 young people (in partnership with Falls Leisure Centre)

‘Lipstick and Lunges’ six week physical activity and healthy eating programme for girls aged 11-16 at La Salle (HHW in partnership with Colin Glen Trust)

Corpus Christi College Year 8 and 9 Pilot (Andersonstown Leisure Centre)

Keep Fit and Swimming sessions with Blackie Community Group

Healthy Lifestyle Programme at La Salle for boys and girls aged 11 to 16; including physical activity and games

Junior Gym twice a week for 11 to 16 year olds at Andersonstown Leisure Centre. Young people are supported to do cardio-workout (HHW in partnership with Colin Glen Trust).

Physical Activity with Adults

Physical Activity Taster Sessions at the three HHW Workplace Health Events (Greater Falls Hub Coordinator in partnership with the Falls Leisure Centre coaches)

Tullymore Walking Group (Upper Falls Hub Coordinator, supported by community partners)

Taxi-Drivers Walking Group (established by the Greater Falls Hub Coordinator following the Black Taxi Company HHW Health Day)

Springvale Walking Group and Pedometer Challenge involving 90 staff and learners

Cardiac Rehabilitation Phase 4 Programme delivered to almost 100 people by the Heart Healthy Living Centre staff (an exercise programme for those progressing from the Cardiac Rehabilitation Phase 3 Programme)

Heart Healthy Living Centre Walking Group and Swimming Group (including some individuals who progressed from the Cardiac Rehabilitation Phase 3 Programme)

GP Exercise by Referral Programme

Zumba classes for ten weeks with parents and children at St Pauls GAA

Activity sessions delivered by the Greater Falls Hub Coordinator at Tar Anall (certificates were presented at the Male and Female HHW Health Days)

Falls Park Run HHW supported the launch (May 2012) and the first anniversary (May 2013) of the Falls Park Run. The Falls Park Run is part of the international Park Run initiative, it is run by volunteers, with a 5 kilometre run (or walk) taking place every Saturday morning. The Falls Park Run has diversified to offering mid-week runs, the ‘couch to 5k’ programme, and themed days. Over 700 people have registered with the Falls Park Run.

Feedback

Children, young people and adults reported that they gained increased confidence and enjoyment of taking part in physical activity.

Many continued to engage in physical activity after the formal programmes finished.

Individuals said that they set themselves personal challenges.

People reported feeling more healthy in themselves, losing weight, and toning up.

A number of people also changed to healthier eating options.

The Healthy Hearts in the West Initiative supported programmes promoting and supporting health eating, diet and nutrition. Poor diet is one of the risk factors to heart health. The Initiative built on existing programmes providing diet and nutrition input, and developed new opportunities, working in partnership with organisations from the community, voluntary, statutory and private sectors.

Healthy Eating and Heart Health

Healthy Eating and Heart Health

Opportunities for Children and Young People

Input into the HHW Fit Kids Physical Activity and Nutrition Programme – delivered by the BHSCT Health Improvement Team Healthy Lifestyle Facilitator and the HHW Hub Coordinators.

Cooking with Class competition with Paul Rankin, involving post primary schools in West Belfast.

Healthy Eating Workshops with girls at St Pauls GAA

St John the Baptist Primary School (P5 pupils) participated in a four week Let’s Cook Programme (healthy eating and cooking).

Paul Rankin Demonstration at the Christian Brothers School

Diet and nutrition input with Sports Clubs, including Immaculata Football Club and St. John’s GAA

‘Lipstick and Lunges’ six week physical activity and healthy eating programme for girls aged 11-16 at La Salle (HHW in partnership with Colin Glen Trust)

Opportunities for Adults

42 adults participated in one of three Healthy Eating Workshops delivered by Belfast Cookery School at Mourne Seafood Restaurant

Cook It training delivered to over 60 people in the community

Belfast Health and Social Care Trust input at HHW Workplace Events

The Community Pharmacists promoted health eating to people participating in the HHW Vascular Risk Screening and Weight Management Programme.

Intergenerational Opportunities

Cook It Programmes delivered in the community with adults, children and young people

HHW Health Day at Lamh Dherg GAA Club

Four week programme: Let’s Cook Your Kids Favourite Meal, involving parents and children in healthy eating and cooking

A Community Cook Book is being developed for the end of the HHW Initiative. Paul Rankin is supporting the Community Cook Book, through contributing recipes and tips in the kitchen.

Dig It, Eat It; two programmes were delivered involving adults and P5 pupils from St. Oliver Plunkett Primary School. The Programme involves planting, growing and harvesting a variety of fruit and vegetables, which were used in the Cook It Programmes and distributed to users of the community centre.

Capacity Building It became evident that there was a lack of diet and nutrition knowledge across the communities; and also that different age groups require different information and facilitation styles. The BHSCT Community Dieticians supported building capacity and knowledge at local level; which will leave a legacy. Key Lesson Learned It is relatively easy, subject to organisations being willing to work in partnership and to recognise the need, to build short nutrition sessions into existing programmes and activities. This enhances lifestyle choices for children, young people and adults.

Baseline Data

In 2012, 1760 pupils (Years 4, 5 and 6) from the 19 Primary Schools in West Belfast completed the

Fit Kids Survey, developed by Healthy Hearts in the West, supported by the Public Health Agency

(building on a questionnaire developed by Healthy Choices in Upper Falls). The Survey aimed to

gain a snapshot of children’s physical activity and eating habits.

Highlights from the Fit Kids Survey data analysis included:

27.5% eat breakfast most school days; 4% never do

19% had ‘take away’ for dinner on previous evening

72% eat less than 5 portions of fruit or vegetables per day

42.4% participate in physical activity three days or less a week;

25.5% participate in physical activity seven days a week (the recommended guideline)

83% reported they enjoy being physically active ‘a lot’

25% watch TV for more than three hours on a school day

In response to this HHW and partners developed and delivered the Fit Kids Physical Activity and

Nutrition Programme.

Fit Kids

Fit Kids

Pilot of the Fit Kids Physical Activity and Nutrition Programme The six-week Pilot Fit Kids Programme was developed in partnership between HHW, Falls Leisure Centre, BHSCT Health Improvement Team and Extended Schools. It comprises 20 minutes on junior spin bikes, 20 minutes ‘circuits’, and 20 minute diet and nutrition workshops. Highlights from the evaluation (involving teachers, coaches and pupils) showed found that children:

Participated in new activities

Made changes to their diet

Showed improved levels of physical fitness

Exhibited Increased levels of interest in physical activity

Showed increased confidence in their ability to participate in physical activity

Retained the information about diet and nutrition given during the Programme (evidenced through the Nutrition Quiz on the final day of the Programme).

Roll-out of the Fit Kids Programme in West Belfast

Building on the pilot, supported by the Belfast City Council Widening Participation Officer (West Belfast) the Fit Kids Physical Activity and Nutrition Programme was delivered from the three West Belfast Leisure Centres (Falls, Andersonstown and Whiterock).

The Fit Kids Programme was adapted in line with the equipment and resources available in each Leisure Centre; following the similar three-part format.

In the past twenty months over 1415 pupils from 17 Primary Schools have participated in the Programme

200 pupils, their parents and teachers attended a Celebration Event in City Hall (December 2012).

Impact Data analysis from the follow-up Fit Kids Survey in 2013 reported that:

75.5% of pupils reported eating less than five portions of fruit and vegetables a day in 2012; this fell to 68.5% in 2013

1.5% of pupils said they never brushed their teeth; this fell to 0.6% in 2013 – the remainder reported brushing their teeth at least once daily.

44.7% reported walking to school in 2012; 55.5% did so in 2013. Even more reported walking home from school each year - 54.6% in 2012 and 67.4% 2013 – indicating a significant increase in this physical activity.

Following negotiations between HHW and Belfast City Council Active Communities Programme, the Active Communities coaches have taken on the delivery of the Fit Kids Physical Activity and Nutrition Programme with Primary Schools in West Belfast. The intention is to roll this Programme out across Belfast. This output demonstrates a sustainable exit strategy.

Critical Reflection and Lessons Learnt

Partnership in action:

Partners working together and agreeing to develop and deliver different tasks contributing to the implementation of a new programme

A win:win outcome in terms of a sustained exit strategy which contributes towards Active Communities meeting their targets

Robust evaluation providing evidence to support review and future development

Positive lifestyle changes

Pragmatic adaptations to the Programme in accordance with resources and need. Further Information Evaluation Report: Phase One HHW Community programmes Evaluation Report: Fit Kids Physical Activity and Nutrition Programme

The Springvale Pathway to a Whole Organisation

Health and Wellbeing Strategy

Springvale Employment and Learning Solutions is a community based centre

providing new skills, qualifications and job opportunities for young people and adults in a range of vocational training areas.

Each year Springvale has an intake of approximately 130 young people aged 16

and 17 years old; who are funded through the Department of Employment and Learning Training for Success Programme.

Of the 2013 – 2014 intake, 5% of the young people have the equivalent of an

English GCSE Grade C and 16% of the young people have the equivalent of a Maths GCSE Grade C.

Baseline data highlights high numbers of young people receiving medication or

counselling for mental health issues, the majority of young people not eating breakfast, the majority consuming higher than recommended alcohol consumption, high numbers of smokers amongst the student population, and suicide ideation.

Springvale approached HHW in early 2012; over the past two years Springvale supported by HHW has delivered a number of health days, physical activity

opportunities, counselling and other interventions supporting health and wellbeing.

Springvale is developing a whole organisation health and wellbeing approach.

The Springvale Pathway to a Whole Organisation Health and Wellbeing Strategy Partnership with Healthy Hearts in the West Springvale initially approached HHW in February 2012 seeking ideas and support for a Smoking Cessation Day for young people. Building on the event (delivered in March 2012) Springvale, supported by HHW, developed opportunities for students and staff to engage in health and wellbeing interventions. These included:

Analysis of existing baseline data

Work Well Questionnaire completed by staff: analysis and action

Lifestyle Survey completed by students: analysis and action

Themed health days

Health and Well Being assessments and diagnostics

Smoking cessation initiatives

Sexual health initiatives

Physical activity programmes

Springvale walking group (staff and learners)

Formation of Student Forum Impact

90 staff and learners have taken part in walking groups and the Springvale walking challenge.

90 young people with a core group of 70 engaged in the Fit 4 Work programme

40 plus young people have been referred to physical activity programmes through the GP Referral Scheme

10 staff and learners have permanently stopped smoking following the Pharmacy Smoking Cessation Programme

7 Catering students and 6 Media students are developing a Cook Book of healthy recipes using mince

20 + young people have sought advice from the Community Pharmacist

2 young people referred to their GP have been diagnosed with diabetes following the Blood Sugar test at a Springvale Health Event

50+ young people have benefited from Counselling

6 members of staff have been referred to their GP with potentially at risk blood pressure results following HHW health events at Springvale; all are now on medication.

Whole Organisation Health and Wellbeing Strategy In autumn 2013 the Springvale Chief Executive, senior managers and Board agreed that they wanted to develop a whole organisation Health and Wellbeing Strategy. The overall aim is to “improve the health and wellbeing of staff and learners through health promotion, information, awareness programmes and activity sessions which encourage self-care”. The development of the Strategy has been supported by the PHA, BHSCT and HHW. Six core themes have been identified:

Physical activity

Diet and nutrition

Emotional wellbeing

Smoking cessation, drugs and alcohol awareness

Health and safety in the workplace

Corporate social responsibility

Critical Factors and Lessons Learnt

Commitment from staff and senior management

The value of learner health and wellbeing assessments, including lifestyle choices

The benefit of programme evaluation to support future intervention

Analysis of exemplars of good practice with this young people

Positive lifestyle changes through individual and group interventions Further Information Barriers to Learning and Attendance Research and Report (February 2014) A number of Springvale Evaluation Report (2012, 2013)

Corpus Christi College is a non-selective Catholic Maintained Post-Primary School in West Belfast; attended by almost 700 pupils.

An internal staff survey identified health and wellbeing as an area of staff concern.

Supported by funding from Active Belfast the College has purchased equipment to establish a small Fitness Suite in a refurbished space within the College.

The College has put table tennis tables around the School, used by pupils during break.

Service management approached HHW to discuss options and opportunities to address health and wellbeing at the College.

HHW has worked with the College to deliver a staff health day, lifestyle surveys with pupils and a pilot programme with years 8 and 9 pupils.

A Healthy School - Corpus Christi College

A Healthy School – Corpus Christi College

Staff Health Day The Corpus Christi College Staff Health Day was organised on the 15th February 2013 for Corpus Christi College Staff, supported by HHW. Information stands and taster sessions were provided by community, statutory and private sector organisations. The Health Day provided staff with the opportunity to engage in:

Health Checks (blood pressure, blood sugars, cholesterol, and BMI measurement)

Physical Activity taster sessions (including circuits and yoga)

Complementary Therapies

Make Up

Diet and Nutrition information

A healthy lunch. The Evaluator/Researcher attended the Health Day and spoke with staff and stand holders. 35 staff completed the HHW Evaluation Questionnaire at the end of the event. Staff Lifestyle Changes Three months after the Health Event, the Principal responded positively to the suggestion of a follow-up evaluation session with staff. A second questionnaire was completed by 38 staff, with a focus on any lifestyle changes they had made since the Health Event.

95% of staff reported making at least one healthy lifestyle improvement

All 7 members of staff referred to GP after potentially high-risk health check results followed up on this advice

27 staff reported eating more healthily

24 staff reported taking better care of health

22 staff reported taking more exercise Critical Reflection and Lessons Learnt for Healthy Workplace Activity

Two members of the College Senior Management Team were committed to opportunities for staff health and wellbeing

Value was placed by the College on evaluation and impact

Opportunities for progression after the health event – i.e. the new Fitness Suite provided opportunities for staff to engage in physical activity before, during and after school hours

Support from other agencies with a remit to engage in health workplaces added value. Further Information Evaluation Report: Corpus Christi College Staff Health Day Evaluation Report: Outcomes from the Corpus Christi College Staff Health Day

The Healthy Hearts in the West Initiative (HHW) was established to mobilise existing resources and assets of communities in West Belfast, and to work with health professionals and other organisations, so that people living in West Belfast experience heart health equivalent to the best in Northern Ireland / Europe. In 2003 the Department of Health highlighted that pharmacists are the biggest untapped resource for health improvement. Pharmacies are located in the ‘heart of communities’, and well placed to make an important contribution to improving public health and the wider promotion of health. Two Community Pharmacy Programmes, aiming to reduce risk factors to heart health, have been piloted in West Belfast, linking into the Healthy Hearts in the West Initiative. The Vascular Risk Screening and the Weight Management Programme are promoted and delivered by ten Pharmacies in West Belfast. Pharmacists delivering the Programmes engaged with individuals raising awareness and advice on diet, physical exercise, alcohol, and smoking to support lifestyle change. The Pharmacists involved with the HHW Community Pharmacy Programmes were expected to follow the same specification and protocols; they had all purchased the same equipment; and completed comprehensive Client Record Forms (developed in consultation with the Public Health Agency, who also collated data and provided the numerical data analysis for the first fourteen months of the Programmes). Delivery of the HHW Community Pharmacy Programmes was supported by the Ulster Chemists Association (UCA). Pharmacists and representatives from UCA supported HHW events; facilitating health checks and providing information and advice. Over 600 people accessed the Keito machine health checks at HHW events.

Healthy Hearts Community Pharmacy Programmes

HHW Community Pharmacy Programmes

Vascular Risk Screening

The Vascular Risk Screening Programme offered a one-to-one consultation with the Pharmacist and a series of health checks, namely: Blood Pressure, Glucose (Blood Sugar), Cholesterol, Body Mass Index (BMI), and Waist Circumference.

757 people have accessed the Community Pharmacy Vascular Risk Screening

162 people have been referred to their GP with potentially high-risk health check results

253 people were signposted by Pharmacists to community heart health programmes. A number of people referred to their GP were invited to take part in a short follow-up survey. A number reported that they have been prescribed medication, predominantly for high blood pressure, but also due to other at-risk health results. A minority were referred to health specialists (for example, due to diabetes). Following conversations with practice managers of GP surgeries in West Belfast the consensus was that HHW and the Risk Screening process provided a beneficial service and that people had not been referred unnecessarily. Weight Management Programme The HHW Weight Management Programme required clients to engage over a six month period. Following the initial one-to-one consultation and health checks, clients were expected to visit the Pharmacy for regular ‘weigh –ins’ using the Keito Machine (which they could personally access); and be able to access advice and support from the Pharmacist (who all received training in Motivational Interviewing Techniques).

104 people enrolled on the Community Pharmacy Weight Management Programme

76 people have completed the Programme; and the client record form data showed that the majority who completed, have lost weight.

Falls Women’s Centre HHW Weight Management Programme The Falls Women’s Centre is a community development organisation established in 1982 in West Belfast by local women. Following discussions, the twelve week HHW Community Pharmacy Programme at The Falls Women's Centre started in January 2013. The Upper Andersonstown HH Coordinator coordinated the Programme; working in partnership with:

The Community Pharmacy Programme Support Pharmacist

Boots the Chemist (one of the Pharmacies participating in the HHW Community Pharmacy Programmes); who provided one-to-one consultations and weekly weigh-ins

The Healthy Lifestyles Facilitator from BHSCT Health Improvement Team to deliver sessions on diet and nutrition

A Colour Breathing facilitator who delivered a workshop. All those involved with delivering the Programme were female, in line with the preferences of the Falls Women’s Centre. The numbers participating reduced from twenty to a core group of twelve women by the third week; all of whom wanted to lose weight and improve their heart health. Regular weigh-in records were available for ten women. Eight women lost 54.9 pounds between them (almost

four stone or 25 kilos) during the twelve week Programme. Two of the women lost over 5% of their body weight. During the evaluation with participants, pharmacist, facilitators and the Centre Director the benefits of participating in the Weight Management Programme as a group were highlighted. The participants reported that they felt supported and motivated by others in the group. The evaluation also highlighted the added value to weight self-management through the programme of workshops.

Lessons Learnt

The individuals who participated in the programmes, benefited from health checks; and the

follow up telephone survey highlighted some very appropriate GP referrals.

The initial implementation of the HHW Community Pharmacy Programmes (Vascular Risk Screening and the Weight Management Programme) was rushed. In retrospect, there may have been benefit in a more staged approach to the Community Pharmacy Programmes, with two or three local pharmacists piloting the programmes. On reflection there was a need for:

Clear specified aims, objectives and outcomes for the intervention

Greater written clarity on the nature and implementation of the intervention.

Clear criteria for Pharmacies delivering services

Clear criteria for client recruitment (i.e. those eligible and not eligible)

Clear criteria and pathways for client referrals (i.e. when clients should be referred to the GP or another agency)

Greater understanding of the need for a high level of data accuracy and completion of the Client Record Form, which is essential to provide evidence for the effectiveness of interventions

A Service Level Agreement or Memorandum of Understanding signed by each participating pharmacy.

The concept that all Pharmacies need to offer the same Programmes is unnecessary. It was evident that some pharmacies had greater success in promoting and retaining clients on the Weight Management Programme than others. Whilst one pharmacy in particular successfully enrolled a number of people onto the Smoking Cessation Programme through presenting information at a number of health events. The lessons learned from the HHW Community Pharmacy programmes should be fed into Health Plus and new developments engaging pharmacies to take on a wider, community based role. Further Information:

HHW Community Pharmacy Programmes: GP Referrals (March 2014)

Evaluation Report Phase One: HHW Community Pharmacy Programmes (January 2014)

HHW Community Pharmacy Programmes Review (September 2012)

Delivering Cardiac Rehabilitation Phase 3 in a Community Setting

Cardiovascular disease (CVD) is a major cause of death and disability in Northern Ireland. People living in West Belfast have the lowest life expectancy in Northern Ireland (average life expectancy for males 72.5 years v Northern Ireland average 77.1 years; for females 78.4 years v Northern Ireland average 81.5 years).

Figures for 2006-2010, show that age standardised mortality rates for circulatory disease were the highest in West Belfast; with 129 deaths per 100,000 compared to the Northern Ireland average of 81 deaths per 100,000.

Healthy Hearts in the West was initiated in response to the high levels of cardiovascular disease across West Belfast and the need to reduce inequalities in heart health. One of the Initiative’s three strands was to promote and support opportunities for rehabilitation for those experiencing heart disease.

The Belfast Health and Social Care Trust Cardiac Rehabilitation Team started delivery of the Cardiac Rehabilitation Phase 3 Programme from the Maureen Sheehan Centre in January 2012.

There has been a 25% increase in the take up of the Cardiac Rehabilitation Phase 3 Programme since it has been delivered from the community setting.

The Cardiac Rehabilitation Nurses have reported patient benefits for those referred to the on-site complementary therapist and counsellors.

Delivering Cardiac Rehabilitation Phase 3 in a Community Setting The Cardiac Rehabilitation Phase 3 Programme

Patients are invited for assessment following hospital discharge to determine whether they are willing and/or clinically ready to attend for the eight week CR Phase 3 Programme

There is robust evidence that comprehensive cardiac rehabilitation is associated with a reduction in both cardiac and total mortality.

Effective cardiac rehabilitation results in improved outcomes for patients with heart disease and reduces unplanned readmissions.

Cardiac rehabilitation improves patients’ functional capacity and their perceived quality of life.

The Programme supports the development of self-management skills and early return to work.

Delivery of Cardiac Rehabilitation Phase 3 Programme at the Maureen Sheehan Centre

The core rationale for delivery of the Cardiac Rehabilitation Phase 3 Programme from the Maureen Sheehan Centre was due to concerns that patients living in West Belfast were not taking up the opportunity to attend Phase 3 Programmes due to the distance they had to travel, and (prior to 2012) that the Programme was not delivered in their own community.

The Cardiac Rehabilitation Phase 3 Programme is delivered by a team of three specialist nurses and one dedicated physiotherapist from Belfast Health and Social Care Trust.

The CR Nurses are able to refer patients to the Counsellor and Complementary Therapist who work with the Heart Healthy Living Centre (located in The Maureen Sheehan Centre). The Nurses report that this additional support helps facilitate achievement of patient goals and in some cases has been instrumental in improving patient engagement and completion of cardiac rehabilitation.

If referred by the Cardiac Phase 3 nurses, people can also attend the Cardiac Rehabilitation Phase 4 Programme which is delivered by the Heart Healthy Living Centre at the Maureen Sheehan Centre.

Outputs The following data were collected for the first fourteen months of the CR Phase 3 Programme delivery from the Maureen Sheehan Centre:

25% increase in the uptake of Cardiac Rehabilitation Phase 3 Programme: figures taken from NACR data in relation to uptake of Phase 3 Programme of patients eligible to participate in Phase 3 at The Grove January to December 2011 (44%), and to the Maureen Sheehan Centre January 2012 to March 2013 (55%)

30 patients on the Cardiac-Rehabilitation Phase 3 Programme were referred to the on-site Counsellor and 53 patients were referred to the on-site Complementary Therapist to access additional support; which the nurses reported added value for the individuals.

96 people enrolled on the Cardiac-Rehabilitation Phase 4 Programme, delivered at the Maureen Sheehan Centre (through the Heart Healthy Living Centre), following Cardiac-Rehabilitation Phase 3.

Further Information: Healthy Hearts in the West Initiative ~ Phase One. Evaluation Report: Cardiac Rehabilitation Phase 3 Programme (March 2014) Cardiac Rehabilitation Phase 3 Programme: Initial Evaluation Report (May 2012)

A Critical Reflection of the Healthy Hearts in the West Initiative

The Healthy Hearts in the West Initiative has demonstrated that a collaborative, community assets approach can support the delivery of key health targets and priorities, as well as offering an innovative approach to addressing health inequality.

The Healthy Hearts in the West Initiative (HHW) was established to mobilise existing resources and assets of communities in West Belfast, and to work with health professionals and other organisations, so that people living in West Belfast experience heart health equivalent to the best in Northern Ireland / Europe.

The community asset approach does not replace investment in improving services or tackling the structural causes of health inequality. The aim is to achieve a better balance between service delivery and community building.

HHW was subject to a robust evaluation process. Throughout the development and delivery of the HHW Initiative, the evaluation captured those interventions that worked well and not so well, exemplars of good practice, and community development models of process and delivery.

HHW has contributed towards disease prevention, primary prevention, and supporting rehabilitation (secondary care) linking directly to integrated care pathways.

A Critical Reflection of the Healthy Hearts in the West Initiative Engaging with people living and working in West Belfast Working with ‘hard-to-reach’ groups, HHW has supported:

People accessing health checks: over 170 people have been referred to their GP following potentially at-risk results

Over 10,000 people sought information about combating risk factors and engaged in heart health initiatives in the first year

Individuals and groups have made behaviour changes, reducing engagement in risk factors that contribute towards heart disease and other chronic conditions. This is supported by qualitative data and case studies, capturing individual experiences, reasons for making lifestyle changes, and demonstrated sustainability.

Successful cross-sectoral partnership initiatives The HHW collaborative, community assets approach has demonstrated that, within an economic context where resources are limited, there are opportunities to make optimum use of resources through working together. Cross-sector initiatives have proven to be successful, including:

The Fit Kids Programme: delivered to over 1400 Primary Schools pupils through a partnership between HHW, Belfast City Council Leisure Centres, BHSCT Health Improvement Team, and Extended Schools

Over 270 young people and 100 staff at Springvale Employment and Learning Solutions (a vocational training centre located in West Belfast for young people and adults) have engaged with HHW, heart health days and programmes.

Adding nutrition workshops and sessions to physical activity programmes delivered in the community by community groups, sporting groups, and Leisure Centres.

Running workplace Healthy Hearts events; followed up with input from the company and other agencies.

Piloting two new programmes through ten Community Pharmacies: 757 people accessed the Vascular Risk Screening and 76 people completed the Weight Management Programme.

Belfast Health and Social Care Trust (BHSCT) Cardiac Rehabilitation Phase 3 Programme has been delivered from a community setting and linked into the Heart Healthy Living Centre Complementary Therapist, Counsellor and Cardiac Rehabilitation Phase 4

Linkages with the Falls Park Run – a weekly event organised by volunteers, which has benefitted from support and input from HHW and partner organisations. Over 700 people have taken part in the Falls Park Run.

Critical Success Factors

Foundation and preparation: including cross-sectoral Planning Days, Baseline Surveys, and a mapping exercise

A community development approach

Linking community infrastructure to local and regional policies and initiatives; with win:win outcomes

Building partnerships with statutory and private sector organisations, such that they are receptive to engaging with community organisations on an equal footing

The community assets model

Linking into existing infrastructure – Social Capital

Drivers, champions, and committed individuals

Supporting behaviour change

Innovation, risk-taking and flexibility within a governable and accountable framework

Understanding local context and culture

Coordination, development and delivery

Placing HHW within the wider health strategy

“Effective local delivery requires effective participatory decision-making at local level. This can only happen by empowering individuals and local communities”.

The Marmot Review, 2010

Further Information:

Healthy Hearts in the West: Critical Reflection (March 2014)

Healthy Hearts in the West Status Report (January 2013)

Ooops ~ what could be improved at gaps in the development and delivery of HHW

The Healthy Hearts in the West Initiative (HHW) was established to mobilise existing resources and assets of communities in West Belfast, and to work with health professionals and other organisations, so that people living in West Belfast experience heart health equivalent to the best in Northern Ireland / Europe.

In an environment where community initiatives rely on short term funding, there appears

to be a culture that implies ‘failure’ is a word not used; and everything is presented as a

success. However, the ‘celebration of failure’ has the potential for greater learning.

Furthermore; where new initiatives and projects experience no failure the question

should be asked as to whether or not they have been innovative and taken assessed

risks to try out new approaches and models.

HHW was subject to a robust evaluation process. Throughout the development and delivery of the HHW Initiative, the evaluation captured those interventions that worked well and not so well, exemplars of good practice, and community development models of process and delivery.

The lessons learnt through those elements of HHW that did not work out as well as

hoped can provide valuable information for future projects.

Ooops ~ what could be improved at gaps in the development and delivery of HHW Gaps Linking into and supporting GP practices HHW endeavoured to engage with GPs initially, but due to lack of clarity regarding other competing interests and demands on GPs time, this work did not progress. There is the opportunity for new initiatives addressing health inequalities to include GPs as major partners. Communication A Communication Strategy was commissioned in April 2012. However, partners did not appear to place a high level of importance on this with regard to offering expertise or resources to further develop the Communication Strategy; and there was insufficient funding to implement this without additional resources. In retrospect the Communication Plan was over-ambitious and did not specify simple tasks that could be measured and reviewed. Signposting people to the HHW Hubs

Data from the Pharmacy Client Forms indicate that 253 people were signposted to the Hubs by Pharmacists. However, no formal follow-up has taken place to record how many people acted on the referral.

In Phase One no Hub referrals, have not been received from Health Professionals, despite initial interest and meeting with the School Nursing Team and Health Visitors. It would be useful to understand why, when a genuine interest was initially expressed, this has not been converted into action.

Cost benefit analysis The evaluation did not include a cost benefit analysis or value (added value) for money. Data collected suggests that the funding has contributed towards a more effective use of resources. Further work could be done to develop a ‘value for money’ model when addressing health inequalities. Opportunity for Improvement Engagement with statutory health teams HHW did not succeed as well as hoped in gaining commitment and engagement with Primary Health Care teams (for example Health Visitors, Community Nurses, and School Nurses). Whilst support was given from senior management, future initiatives need to look at ways in which effective engagement with statutory health programmes can effectively be developed. Coordination of the HHW Initiative In hindsight, expecting the West Belfast Partnership Health Development Coordinator to manage the HHW Initiative in addition to the ‘day job’ was unrealistic. The role of the HH Coordinator was further hindered by the fact that the Hub Coordinators were not accountable on a daily basis to the HH Coordinator, and were not line-managed by him. This made it more difficult to provide a consistent HHW approach across the three Hubs, despite each Hub having the same targets and action plans (which took into account community characteristics). Heart Health Champions A small number of community and voluntary groups have identified ‘heart health champions’. There is the opportunity to formally build on this, through the structured provision of resources, workshops, updates and support. HHW Community Pharmacy programmes

The initial implementation of the HHW Community Pharmacy Programmes (Vascular Risk Screening and the Weight Management Programme) was rushed. On reflection there was a need for clearer aims, objectives and outcomes; clear criteria for Pharmacies delivering services; greater clarity about the criteria and pathways for client referrals; and a Service Level Agreement or Memorandum of Understanding signed by each participating pharmacy. Workplace health events The three HHW Workplace Health Events were all viewed as a success on the day; however follow-up after the initial Health Event varied. Basic criteria should be developed to support decision making about in which organisations HHW Health Events should be delivered; including how the organisation intends to build on the Health Event (to gain maximum impact). Partner organisations with a remit to support health in the workplace should be pro-actively engaged in the delivery of the Workplace Health Events; and offer workplaces options to build on and sustain healthy lifestyle options. Further Information:

Healthy Hearts in the West: Critical Reflection (March 2014)

Healthy Hearts in the West Status Report (January 2013)

Healthy Hearts in the West has been operational for 27 months; seeking to address heart health inequality through developing and delivering a collaborative, community assets model.

Cardiovascular disease (CVD) is a major cause of death and disability in Northern Ireland. Mortality rates for circulatory disease were the highest in West Belfast with 129 deaths per 100,000 compared to the Northern Ireland average of 81 deaths per 100,000 (2006 – 2010).

HHW built on the community infrastructure; promoting and increasing access to heart health programmes and activities across West Belfast.

HHW has been recognised by the National Institute of Clinical Excellence and awarded a joint first award by Belfast Healthy Cities.

Active Communities coaches are now delivering the physical activity element of the Fit Kids Physical Activity and Nutrition Programme.

Springvale Employment and Learning Solution and Corpus Christi College are developing whole organisation approaches to health and wellbeing.

221 people have been trained in heart health related programmes.

Cardiac Rehabilitation Phase 3 will continue to be delivered from the Maureen Sheehan Centre.

Recognition and Legacy

Recognition and Legacy

Recognition of the HHW Initiative

The collaborative community assets model developed within Healthy Hearts in the West is one of twenty initiatives shortlisted for a National Institute of Clinical Excellence Shared Learning Award (shortlist announced February 2014, awards made in May 2014, England).

HHW was awarded joint first place for the Belfast Healthy Cities ‘Promoting Health Equity’ award (December 2013, Belfast).

A HHW paper ‘Turning the Tide on Obesity in West Belfast’ was selected for presentation at the Faculty of Public Medicine Winter Conference; and a Poster Presentation of HHW putting ‘Marmot in Action’ was also delivered at the same event (December 2013, Dublin).

Sustainability – The HHW legacy for West Belfast

Following negotiations between HHW and Belfast City Council Active Communities Programme, the Active Communities coaches have taken on the delivery of the Fit Kids Physical Activity and Nutrition Programme with Primary Schools in West Belfast. The intention is to roll this Programme out across Belfast. This output demonstrates a sustainable exit strategy.

Springvale Employment and Learning Solutions is currently developing a whole organisation health and wellbeing strategy for learners and staff. This is a sustainable legacy from HHW; and has been developed with support from HHW. It is building on the partnership work with HHW, the health days,lifestyle choice surveys (with staff and learners), and the Fit 4 Work Programme with young people (in partnership with the Falls Leisure Centre).

221 people living and working (employees and volunteers) in the community have been trained in a range of heart health related programmes. These include Level 2 Gym Instructor, Weigh to Health, Cook It, Walk Leader Training, British Heart Foundation Toolkits, and Level 3 Exercise by Referral.

The Cardiac-Rehabilitation Phase 3 Programme will continue to be delivered from the Maureen Sheehan Centre. There is no reason to suggest that the 25% increase in take up to the invitation to attend the Programme by eligible patients will not continue. This has an impact on the perceived quality of life for those who participate in the CR Phase 3 Programme, patients’ functional capacity, reduces unplanned hospital readmissions, and improves cardiac and total mortality.

The Pharmacists who delivered the HHW Community Pharmacy Programmes report that customers seek more information from the Pharmacists in relation to general health, lifestyle choices, and minor ailments. This has an impact on people making appointments with the GP, which can be addressed quickly and easily in the community.

Corpus Christi College is developing a healthy school model, not only involving staff and pupils, but also extending opportunities to the wider community.

Wider Impact

The Patient Follow-Up Questionnaire developed by HHW for patients attending the Cardiac-Rehabilitation Phase 3 Programme at the Maureen Sheehan Centre (which is in line with the CVD Framework Standards) has been used by all Health Trust Cardiac Rehabilitation Centres in Northern Ireland.

Initial conversations and discussions with the Pulmonary Rehabilitation Team and representatives from Belfast City Council have contributed to the Pulmonary Rehabilitation progression programme, being piloted in The Grove Health and Wellbeing Centre (North Belfast) and the Falls Leisure Centre (West Belfast).

Further Information

HHW Statistics Paper (March 2013)

Phase One Evaluation Reports: One, Two, Three and Four

NICE Shared Learning website

Healthy Hearts in the West Tool Kit

From the outset, the Healthy Hearts in the West Initiative has been subject to a robust formative and summative evaluation process. The HHW Evaluator / Researcher has been supported by a cross-sectoral Evaluation and Monitoring Subgroup. During the Initiative a number of processes, surveys, and questionnaires have been developed, often in consultation with and support from the Public Health Agency and other members of the Evaluation and Monitoring Subgroup (including representatives from Queen’s University Belfast and the Eastern Health Board). It was agreed that one of the legacies from HHW should be that other organisations can access and make use of the surveys and questionnaires. The HHW Toolbox also provides brief overviews of the processes that have informed HHW Health Days, focus group facilitation, collecting case studies, a logic model approach and the NICE Behaviour Change guidelines. Questionnaires and Surveys

Community Baseline Approaches

Workplace Baseline Survey

Health Event Evaluation Questionnaires – for participants and stand holders

Follow-Up Health Event Evaluation Questionnaire

Partnership Review Questionnaire (can be used as a Baseline and Follow-Up)

Follow-Up Patient Satisfaction Questionnaire

Lifestyle Survey for young people (suitable for ages eleven to twenty years)

Fit Kids Survey (suitable for ages seven to eleven years)

Follow-Up Referral Telephone Interview Planning Health Events

Process

Contacts

Promotion Miscellaneous

A community assets approach

Developing Case Studies: process and question examples

Developing a Logic Model

Facilitating Focus Groups

Short Interviews with people following GP referrals

National Institute for Clinical Excellence (NICE) Behaviour Intervention Guidelines (PH6)

Resources Further Information

The HHW Toolbox resources can be downloaded http://www.westbelfast-partnership.com/